Household Income Decline and Job Loss Among Survivors of Critical Illness: A Nationwide Cohort Study

OBJECTIVES: To assess the socioeconomic consequences of critical illness by quantifying changes in household income level and unemployment among ICU survivors in a universal health coverage setting. DESIGN, SETTING, AND PATIENTS: This nationwide retrospective cohort study used the Korean National Health Insurance Service database. Adult ICU survivors between January 1, 2020, and December 31, 2022, were included. Patients who died within 1 year or had missing data were excluded. The final cohort consisted of 582,341 survivors. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the change in household income level (scale 0-20) between pre-ICU and post-ICU years, analyzed using generalized estimating equation models. The most salient finding was a profound financial polarization among survivors. While the overall cohort experienced a significant and progressive decline in income rank (1-yr ratio of means RoM, 0.994; 2-yr RoM, 0.976; both p < 0.001), this average masked a severe impact on the highest income quartile (Q4), which exhibited a substantial 6.5% relative drop in mean rank (RoM, 0.935). In contrast, the lowest quartile (Q1) showed relative stability (RoM, 2.198) due to a "floor effect" and transitions into the social safety net. Descriptively, 160,682 survivors (27.6%) experienced income decline, 60,432 (10.4%) suffered catastrophic decline, and 12.3% of 326,125 previously employed survivors were no longer employed within 1 year. CONCLUSIONS: Critical illness is associated with progressive socioeconomic deterioration characterized primarily by financial polarization. Even with universal health coverage, the economic burden hits previously high-earning households most severely, while lower income groups face potential asset depletion before transitioning to social safety nets. Policies integrating sustained financial protection and vocational rehabilitation into post-ICU survivorship care are essential.